ASSESSING AND TREATING PATIENTS WITH SLEEP/WAKE DISORDERS -

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Decision Tree: Insomnia case

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I want you to answer the questions given to you (decision points one, two, and three) before you click on the option. The answers will be based on your decisions made and patient outcomes during the decision tree. I am looking for an essay that is long enough to cover the topic BUT short enough to keep my interest. The course page suggests writing 1 page per decision – my opinion is that it will be very difficult to justify your treatment decisions and provide scientific evidence in 1 page (especially for decision #1). I do not need you to tell me about the patient or the treatment options available to you – I am very familiar with the cases. Your introductory page should be an overview of the disease state you are treating along with a purpose statement for the assignment. Remember this is a Pharmacology class that incorporates Pharmacotherapy and not a class on diagnosing disease. I want you to tell me why you selected an option – why is it the best option, using clinically relevant data from primary literature (clinical trials, treatment guidelines) and patient specific data AND why you did not choose the other options (with clinically relevant data from primary literature and patient specific data).

Introduction to the case (1 page)

Briefly explain and summarize the disease state you are treating this Assignment. Be sure to include the specific patient factors that may impact your decision making when prescribing medication for this patient.
At each decision point stop to complete the following:
THE ASSIGNMENT: 5 PAGES

Examine Case Study: Pharmacologic Approaches to the Treatment of Insomnia in a Younger Adult. You will be asked to make three decisions concerning the medication to prescribe to this patient. Be sure to consider factors that might impact the patient’s pharmacokinetic and pharmacodynamic processes.

At each decision point, you should evaluate all options before selecting your decision and moving throughout the exercise. Before you make your decision, make sure that you have researched each option and that you evaluate the decision that you will select. Be sure to research each option using the primary literature.

Decision #1 (1.5+ pages)

Which decision did you select?
Why did you select this decision? Support your response with strong scientific evidence discussing efficacy, safety, tolerability and patient outcomes from primary literature (not information from Micromedex, Epocrates or UpToDate) and references. Why did you NOT select the other treatment options available? Again, provide STRONG scientific evidence from the primary literature. Clinical studies or treatment guidelines are a good place to start!
What were you hoping to achieve by making this decision? Support your response with evidence and references to the Learning Resources.
What ethical considerations impacted your treatment plan and communication plan with the patient?

Decision #2 (1+ pages)

Decision #3 (1+ pages)

Conclusion (1 page)

Summarize your recommendations on the treatment options you selected for this patient. Be sure to justify your recommendations and support your response with clinically relevant and patient-specific resources, including the primary literature. You should provide new data here – not a repeat of the data you used previously in the paper.

After writing up your rationale at each decision point, I would ask yourself the following questions:

Have I provided clinical data from a meta-analysis, case report or clinical trial to support the drug I picked being safe, efficacious and the best choice for this patient? If the answer is NO, you’ll want to start over
Have I provided clinical data, etc. to support a clear rationale as to why the other treatment options are NOT optimal? If the answer is NO, you’ll want to start over
Is the focus of my discussion on mechanism of action and receptors/neurotransmitters that the drug acts on? If the answer is YES, you should consider doing additional research to address the above two questions

Also include how ethical considerations might impact your treatment plan and communication with clients.

The rubric, as I interpret it, suggests 5 references cited with every assignment for full credit on this portion (20 points). References used for your introductory paragraph, ethical considerations or conclusion do not count towards the 5 references required. As a general rule of thumb, I would encourage you to reference AT LEAST two sources (not including the textbook) for each decision point – this will result in 6 references total for your clinical decision making.

Note: Support your rationale with a minimum of five academic resources. While you may use the course text to support your rationale, it will not count toward the resource requirement. You should be utilizing the primary and secondary literature.

Reminder : The College of Nursing requires that all papers submitted include a title page, introduction, summary, and references. The Sample Paper provided at the Walden Writing Center provides an example of those required elements (available at https://academicguides.waldenu.edu/writingcenter/templates/general#s-lg-box-20293632)

Insomnia
31-year-old Male

BACKGROUND

This week, we examine a 31-year-old male who presents to the office with a chief complaint of insomnia.

SUBJECTIVE

Patient is a 31-year-old male. He states that his insomnia has gotten progressively worse over the past 6 months. Per the patient, he has never been a “great sleeper” but is now having difficulty both falling asleep and staying asleep at night. The problem began approximately 6 months ago after the sudden loss of his fiancé. The patient states this is affecting his ability to perform his job, which is a forklift operator at a local chemical company. The patient states he has used diphenhydramine in the past to sleep but does not like the way it makes him feel the morning after. He states he has fallen asleep on the job due to lack of sleep from the night before. The patient’s medical record from his previous physician states that he has a history of opiate abuse, which began after he broke his ankle in a skiing accident and was prescribed hydrocodone/apap (acetaminophen) for acute pain management. The patient has not received a prescription for an opiate analgesic in 4 years. The patient states recently he has been using alcohol to help him fall asleep, approximately four beers prior to bed.

MENTAL STATUS EXAM

The patient is alert and oriented to person, place, time, event. He makes good eye contact and is dressed appropriately for time of year. He denies auditory/visual hallucinations. Judgement, insight, and reality contact are all intact. Patient denies suicidal/homicidal ideation, and is future oriented.

Decision Point One

Select what you should do:

Zolpidem: 10 mg daily at bedtime

Trazodone 50 mg po at bedtime

Hydroxyzine: 50 mg daily at bedtime

NURS_6630_Week8_Assignment2_Rubric

Criteria Ratings Pts

This criterion is linked to a Learning OutcomeIntroduction to the case (1 page)Briefly explain and summarize the case for this Assignment. Be sure to include the specific patient factors that may impact your decision making when prescribing medication for this patient.

10 to >8.0 pts

Excellent Point range: 90–100

The response accurately, clearly, and fully summarizes in detail the case for the Assignment…. The response accurately and clearly explains in detail the specific patient factors that impact decision making when prescribing medication for this patient.

8 to >7.0 pts

Good Point range: 80–89

The response accurately summarizes the case for the Assignment…. The response accurately explains the specific patient factors that impact decision making with prescribing medication for this patient.

7 to >6.0 pts

Fair Point range: 70–79

The response inaccurately or vaguely summarizes the case for the Assignment…. The response inaccurately or vaguely explains the specific patient factors that impact decision making with prescribing medication for this patient.

6 to >0 pts

Poor Point range: 0–69

The response inaccurately and vaguely summarizes the case for the Assignment, or is missing…. The response inaccurately and vaguely explains the specific patient factors that impact decision making with prescribing medication for this patient.

10 pts

This criterion is linked to a Learning OutcomeDecision #1 (1–2 pages)• Which decision did you select?• Why did you select this decision? Be specific and support your response with clinically relevant and patient-specific resources, including the primary literature.• Why did you not select the other two options provided in the exercise? Be specific and support your response with clinically relevant and patient-specific resources, including the primary literature.• What were you hoping to achieve by making this decision? Support your response with evidence and references to the Learning Resources (including the primary literature).• Explain how ethical considerations may impact your treatment plan and communication with patients. Be specific and provide examples.

20 to >17.0 pts

Excellent Point range: 90–100

The response accurately and clearly explains in detail the decision selected…. The response accurately and clearly explains in detail why the decision was selected, with specific clinically relevant resources that fully support the decision selected…. The response accurately and clearly explains in detail why the other two responses were not selected, with specific clinically relevant resources that fully support the response…. The response accurately and clearly explains in detail the outcome the student was hoping to achieve with the selected decision, with specific clinically relevant resources that fully support the response…. The response accurately and clearly explains in detail how ethical considerations impact the treatment plan and communication with patients…. Examples provided fully support the decisions and responses provided.

17 to >15.0 pts

Good Point range: 80–89

The response accurately explains the decision selected…. The response explains why the decision was selected, with specific clinically relevant resources that support the decision selected…. The response accurately explains why the other two responses were not selected, with specific clinically relevant resources that support the response…. The response accurately explains the outcome the student was hoping to achieve with the selected decision, with specific clinically relevant resources that support the response…. The response accurately explains how ethical considerations impact the treatment plan and communication with patients…. Examples provided support the decisions and responses provided.

15 to >13.0 pts

Fair Point range: 70–79

The response inaccurately or vaguely explains the decision selected…. The response inaccurately or vaguely explains why the decision was selected, with specific clinically relevant resources that inaccurately or vaguely support the decision selected…. The response inaccurately or vaguely explains why the other two responses were not selected, with specific clinically relevant resources that inaccurately or vaguely support the response…. The response inaccurately or vaguely explains the outcome the student was hoping to achieve with the selected decision, with specific clinically relevant resources that inaccurately or vaguely support the response…. The response inaccurately or vaguely explains how ethical considerations impact the treatment plan and communication with patients…. Examples provided may support the decisions and responses provided.

13 to >0 pts

Poor Point range: 0–69

The response inaccurately and vaguely explains the decision selected…. The response inaccurately and vaguely explains why the decision was selected, with specific clinically relevant resources that do not support the decision selected, or is missing…. The response inaccurately and vaguely explains why the other two responses were not selected, with specific clinically relevant resources that do not support the decision selected, or is missing…. The response inaccurately and vaguely explains the outcome the student was hoping to achieve with the selected decision, with specific clinically relevant resources that do not support the response, or is missing…. The response inaccurately and vaguely explains how ethical considerations impact the treatment plan and communication with patients, or is missing…. Examples provided do not support the decisions and responses provided, or is missing.

20 pts

This criterion is linked to a Learning OutcomeDecision #2 (1–2 pages)• Which decision did you select?• Why did you select this decision? Be specific and support your response with clinically relevant and patient-specific resources, including the primary literature.• Why did you not select the other two options provided in the exercise? Be specific and support your response with clinically relevant and patient-specific resources, including the primary literature.• What were you hoping to achieve by making this decision? Support your response with evidence and references to the Learning Resources (including the primary literature).• Explain how ethical considerations may impact your treatment plan and communication with patients. Be specific and provide examples.

20 to >17.0 pts

Excellent Point range: 90–100

17 to >15.0 pts

Good Point range: 80–89

15 to >13.0 pts

Fair Point range: 70–79

13 to >0 pts

Poor Point range: 0–69

The response inaccurately and vaguely explains in detail the decision selected…. The response inaccurately and vaguely explains why the decision was selected, with specific clinically relevant resources that do not support the decision selected, or is missing…. The response inaccurately and vaguely explains why the other two responses were not selected, with specific clinically relevant resources that do not support the decision selected, or is missing…. The response inaccurately and vaguely explains the outcome the student was hoping to achieve with the selected decision, with specific clinically relevant resources that do not support the response, or is missing…. The response inaccurately and vaguely explains how ethical considerations impact the treatment plan and communication with patients, or is missing…. Examples provided do not support the decisions and responses provided, or is missing.

20 pts

This criterion is linked to a Learning OutcomeDecision #3 (1–2 pages)• Which decision did you select?• Why did you select this decision? Be specific and support your response with clinically relevant and patient-specific resources, including the primary literature.• Why did you not select the other two options provided in the exercise? Be specific and support your response with clinically relevant and patient-specific resources, including the primary literature.• What were you hoping to achieve by making this decision? Support your response with evidence and references to the Learning Resources (including the primary literature).• Explain how ethical considerations may impact your treatment plan and communication with patients. Be specific and provide examples.

20 to >17.0 pts

Excellent Point range: 90–100

17 to >15.0 pts

Good Point range: 80–89

15 to >13.0 pts

Fair Point range: 70–79

13 to >0 pts

Poor Point range: 0–69

20 pts

This criterion is linked to a Learning OutcomeConclusion (1 page)• Summarize your recommendations on the treatment options you selected for this patient. Be sure to justify your recommendations and support your response with clinically relevant and patient-specific resources, including the primary literature.

15 to >13.0 pts

Excellent Point range: 90–100

The response accurately and clearly summarizes in detail the recommendations on the treatment options selected for this patient…. The response accurately and clearly explains a justification for the recommendations provided, including clinically relevant resources that fully support the recommendations provided.

13 to >11.0 pts

Good Point range: 80–89

The response accurately summarizes the recommendations on the treatment options selected for this patient…. The response accurately explains a justification for the recommendation provided, including clinically relevant resources that support the recommendations provided.

11 to >10.0 pts

Fair Point range: 70–79

The response inaccurately or vaguely summarizes the recommendations on the treatment options selected for this patient…. The response inaccurately or vaguely explains a justification for the recommendations provided, including clinically relevant resources that inaccurately or vaguely support the recommendations provided.

10 to >0 pts

Poor Point range: 0–69

The response inaccurately and vaguely summarizes the recommendations on the treatment options selected for this patient, or is missing…. The response inaccurately and vaguely explains a justification for the recommendations provided, including clinically relevant resources that do not support the recommendations provided, or is missing.

15 pts

This criterion is linked to a Learning OutcomeWritten Expression and Formatting – Paragraph Development and Organization: Paragraphs make clear points that support well-developed ideas, flow logically, and demonstrate continuity of ideas. Sentences are carefully focused—neither long and rambling nor short and lacking substance. A clear and comprehensive purpose statement and introduction are provided that delineate all required criteria.

5 to >4.0 pts

Excellent Point range: 90–100

Paragraphs and sentences follow writing standards for flow, continuity, and clarity…. A clear and comprehensive purpose statement, introduction, and conclusion are provided that delineate all required criteria.

4 to >3.5 pts

Good Point range: 80–89

Paragraphs and sentences follow writing standards for flow, continuity, and clarity 80% of the time….Purpose, introduction, and conclusion of the assignment are stated, yet they are brief and not descriptive.

3.5 to >3.0 pts

Fair Point range: 70–79

Paragraphs and sentences follow writing standards for flow, continuity, and clarity 60%–79% of the time…. Purpose, introduction, and conclusion of the assignment is vague or off topic.

3 to >0 pts

Poor Point range: 0–69

Paragraphs and sentences follow writing standards for flow, continuity, and clarity < 60% of the time.... No purpose statement, introduction, or conclusion were provided. 5 pts This criterion is linked to a Learning OutcomeWritten Expression and Formatting - English writing standards: Correct grammar, mechanics, and proper punctuation 5 to >4.0 pts

Excellent Point range: 90–100

Uses correct grammar, spelling, and punctuation with no errors.

4 to >3.5 pts

Good Point range: 80–89

Contains a few (1 or 2) grammar, spelling, and punctuation errors.

3.5 to >3.0 pts

Fair Point range: 70–79

Contains several (3 or 4) grammar, spelling, and punctuation errors.

3 to >0 pts

Poor Point range: 0–69

Contains many (≥ 5) grammar, spelling, and punctuation errors that interfere with the reader’s understanding.

5 pts

This criterion is linked to a Learning OutcomeWritten Expression and Formatting – The paper follows correct APA format for title page, headings, font, spacing, margins, indentations, page numbers, parenthetical/in-text citations, and reference list.

5 to >4.0 pts

Excellent Point range: 90–100

Uses correct APA format with no errors.

4 to >3.5 pts

Good Point range: 80–89

Contains a few (1 or 2) APA format errors.

3.5 to >3.0 pts

Fair Point range: 70–79

Contains several (3 or 4) APA format errors.

3 to >0 pts

Poor Point range: 0–69

Contains many (≥ 5) APA format errors.

5 pts

Total Points: 100

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1
Title of the Paper in Full Goes Here
Student Name Here
Program Name or Degree Name, Walden University
Course Number, Section, and Title
(Example: NURS 0000 Section 01, Title of Course)
Instructor Name
Month, Day, Year
(enter the date submitted to instructor)
2
Title of the Paper
This is your introductory paragraph designed to inform the reader of what you will cover
in the paper. (BSN Students – Carefully follow your course-specific Grading Rubric concerning
the content that is required for your assignment and the Academic Writing Expectations [AWE]
level of your course.) This template’s formatting—Times New Roman 12-point font (other
options include Calibri 11, Arial 11, Lucida Sans Unicode 10, and Georgia 11), double spacing,
1” margins, 1/2” indentations beginning of each paragraph, page numbers, and page breaks—is
set for you, and you do not need to change it. Do not add any extra spaces between the heading
and the text (you may want to check Spacing under Paragraph, and make sure settings are all set
to “0”). The ideas in this paper should be in your own words and supported by credible outside
evidence. Cite the author, year of publication, and page number, if necessary, per APA. The
introductory paragraph should receive no specific heading because the first section functions as
your paper’s introduction. Build this paragraph with the following elements:
1. Briefly detail what has been said or done regarding the topic.
2. Explain the problem with what has been said or done.
3. Create a purpose statement (also commonly referred to as a thesis statement) as the last
sentence of this paragraph: “The purpose of this paper is to describe…”.
Level 1 Heading (Name According to the Grading Rubric Required Content)
This text will be the beginning of the body of the paper. Even though this section has a
new heading, make sure to connect this section to the previous one so the reader can follow
along with the ideas and research presented. The first sentence, or topic sentence, in each
paragraph should transition from the previous paragraph and summarize the main point in the
paragraph. Make sure each paragraph addresses only one topic. When you see yourself drifting
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to another idea, make sure you break into a new paragraph. Avoid long paragraphs that are more
than three-fourths of a page. Per our program recommendations, each paragraph should be at
least 3-4 sentences in length and contain a topic sentence, evidence, analysis, and a conclusion or
lead out sentence. See the MEAL plan (Main idea, Evidence, Analysis, and Lead out) in the
Writing Center. In your paragraphs, synthesize your resources/readings into your own words and
avoid using direct quotations. In the rare instances you do use a direct quotation of a historical
nature from a source, the page or paragraph numbers are also included in the citation. For
example, Leplante and Nolin (2014) described burnout as “a negative affective response
occurring as result of chronic work stress” (p. 2). When you transition to a new idea, you should
begin a new paragraph.
Another Level 1 Heading (Name According to the Grading Rubric Required Content)
Here is another Level 1 heading. Again, the topic sentence of this section should explain
how this paragraph is related to or a result of what you discussed in the previous section.
Consider using transitions between sentences to help readers see the connections between ideas.
Be sure to credit your source(s) in your paper using APA style. The APA Manual 7th
edition and the Walden Writing Center are your best citation resources. Writing Center resources
are available at https://academicguides.waldenu.edu/writingcenter/apa/citations. You must
appropriately and correctly cite all works used in your document.
The following paragraph provides examples of in-text citation examples. According to
Leplante (2019), employers cause burnout when employees are stressed by too much work. Or
you might write and cite in this manner: Employers cause burnout when employees are stressed
by too much work (Leplante, 2019). When paraphrasing, the author name and year of publication
in citations is required by APA to direct the reader to a specific source in the reference list.
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Personal communications are not listed in the reference page but are noted in text as (S. Wall,
personal communication, May 24, 2019). This should immediately follow the content of the
interview. Also, go to
Another Level 1 Heading (Name According to the Grading Rubric Required Content)
APA can seem difficult to master, but following the general rules becomes easier with
use. The Writing Center also offers numerous APA resources on its website and can answer your
questions via email. Prior to submitting your paper for grading, submit your draft to SafeAssign
Drafts found in the left column of your course.
And so forth until the conclusion….
Conclusion
The conclusion section should recap the major points of your paper. Do not introduce
new ideas in this paragraph; the conclusion should interpret what you have written and what it
means in the bigger picture.
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References
Please note that the following references are intended as examples only. List your own
references in alphabetical order. Also, these illustrate different types of references; you are
responsible for any citations not included in this list. In your paper, be sure every reference entry
matches a citation, and every citation refers to an item in the reference list.
Journal Article; Two Authors; DOI
Leplante, J. P. & Nolin, C. (2014). Consultas and socially responsible investing in Guatemala: A
case study examining Maya perspectives on the Indigenous right to free, prior, and
informed consent. Society & Natural Resources, 27(4), 231–248.
https://doi.org/10.1080/08941920.2013.861554
Journal Article, Two Authors; URL
Eaton, T. V., & Akers, M. D. (20007). Whistleblowing and good governance. CPA Journal,
77(6), 66–71. http://archives.cpajournal.com/2007/607/essentials/p58.htm
Journal Article, More Than Twenty Authors; DOI
Wiskunde, B., Arslan, M., Fischer, P., Nowak, L., Van den Berg, O., Coetzee, L., Juárez, U.,
Riyaziyyat, E., Wang, C., Zhang, I., Li, P., Yang, R., Kumar, B., Xu, A., Martinez, R.,
McIntosh, V., Ibáñez, L. M., Mäkinen, G., Virtanen, E., . . . Kovács, A. (2019). Indie pop
rocks mathematics: Twenty One Pilots, Nicolas Bourbaki, and the empty set. Journal of
Improbable Mathematics, 27(1), 1935–1968. https://doi.org/xxx/xxxxxx
Book; One Author
Weinstein, J. A. (2019). Social change (3rd ed.). Rowman & Littlefield.
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Book; Chapter in an Edited Book
Christensen, L. (2020). For my people: Celebrating community through poetry. In B. Bigelow,
B. Harvey, S. Karp, & L. Miller (Eds.), Rethinking our classrooms: Teaching for equity
and justice (Vol. 2; pp. 16–17). Rethinking Schools.
Professional Organization Web page
Centers for Disease Control and Prevention. (2018). Back to school.
https://www.cdc.gov/features/teens-back-to-school/index.html
Professional Organization Book
American Nurses Association. (2010). Nursing: Scope and standards of practice (2nd ed.).
Two or more works by same author in the same year
Wall, S. (2018a). Effects of friendship on children’s behavior. Journal of Social Psychology,
4(1), 101–105.
Wall, S. (2018b). Trials of parenting adolescents with deviant behaviors. Journal of Child
Psychology, 4(12), 161–167.
Government Article
National Institute of Mental Health. (1990). Clinical training in serious mental illness (DHHS
Publication No. ADM 90-1679). U.S. Government Printing Office.
Lecture Notes
Health effects of exposure to forest fires [Lecture notes]. (2019). Walden University Blackboard.
https://class.waldenu.edu
Personal Communication (Only Goes in Body of Paper and not in References)
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Video
Walden University. (2009). Title of video here [Video]. Walden University Blackboard.
https://class.waldenu.edu
Television (Audio)
Important, I. M. (Producer). (1990, November 1). The nightly news hour [TV series episode].
Central Broadcasting Service.
APA Resources
You have other several options to assist you in the formulation of your reference page.
•
Your American Psychological Association (APA) Manual is your best reference
resource. Use the current edition with a copyright date of 2020.
•
The Walden Writing Center also a great place for referencing advice at
https://academicguides.waldenu.edu/writingcenter/apa/references.
•
Citation and reference examples are provided in the ‘BSN TOP Ten References and
Citations” handout found in the Writing Resources tab of the course. This document
covers the 10 most commonly used reference and citation formats. You are responsible
for looking up any that are not included on this list.

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